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Thursday, 7 April 2016

13 Reasons You Wake Up in the Middle of the Night

Waking up in the night can be very frustrating and leave you screaming "why can't I sleep?!" And, although sometimes the reason why you've woken up is obvious, there are also some lesser known physical and emotional factors that could be disturbing your sleep. The experts explain...

1. You're coughing.

If a cough wakes you, it's likely to be caused by stomach acid splashing up the gullet and irritating the back of the throat. Known as nocturnal or atypical reflux, it's made worse by lying flat and usually happens a couple of hours after going to sleep. Those who suffer from reflux during the day are more likely to be affected, says Vishal Saxena, Consultant Gastroenterologist at the Queen Elizabeth Hospital in London. Other symptoms include heartburn and an acid or sour taste in the mouth.

What to do: Watch your weight. Carrying a few extra pounds around your stomach can increase the likelihood of an attack as it creates pressure on the abdomen, pushing the contents of the gut up the gullet. Try to avoid heavy meals six hours before going to bed, and sleep propped up on pillows.

2. You need to go to the bathroom.

A full bladder could be an early sign of both type 1 and type 2 diabetes, as the body tries to get rid of sugar through urine. Needing the bathroom at night can also be a sign of underlying problems such as fibroids — benign tumors on the wall of the uterus that can cause it to enlarge and squash the bladder. Or it may be caused by cystitis — inflammation or swelling of the bladder lining because of infection or inflammation.

What to do: If you experience any symptoms of diabetes you should see your doctor for a blood test. Cystitis can be treated with antibiotics.

3. You're out of breath.

Did you know there is such a thing as nocturnal asthma? Some people only realize they have it because it wakes them at night. It can also bring on coughing fits.

What to do: Air conditioning, bed mites or down duvets can trigger an attack. Try changing your type of bedding or soft furnishings to see if that helps. If it is asthma, your GP can prescribe a long-acting corticosteroid inhaler to open the airways.

4. You feel dizzy.

If you wake up feeling dizzy, you could be suffering from benign positional vertigo. This happens when microscopic fragments of debris break off from the lining of the inner ear — usually as a result of infection or inflammation — and get into one of the fluid-filled canals of the middle ear, confusing balancing signals to the brain, which then brings on dizziness.

What to do: Sleeping on your back on two pillows may help, as it stabilizes the position of the head, says Dr. Ayham Al-Ayoubi, an ENT and facial surgeon at London's Chase Farm Hospital. If you do wake up dizzy, put on a soft light next to your bed — don't close your eyes, as the visual messages we get from sight help re-order the confusing messages being sent to the brain. Then, focus on an object for a few minutes. As you stay in this fixed position, the disturbing signals will settle down, calming the dizzy spell. The problem can be treated by an ENT specialist using the Epley maneuver. This involves shifting the patient's head slowly through a precise sequence of positions while they're lying down or sitting up.

5. Your back is aching.

Sleeping with too many pillows can put strain on the lower back. The best position to sleep in is on your back with one pillow under your neck and one under your knees, as this will support the lower back.

What to do: Your mattress could be too hard or too soft. When testing a new one, lie on your back and check whether you can put your hand in the gap between your spine and the mattress. If there is a big gap, the mattress is too hard; if you can't get your fingers out easily, the mattress is too soft.

6. You're too hot.

Night sweats are a classic sign of menopause, but can also be caused by drinking too much alcohol or due to a side effect of anti-depressants. "In rare cases, night sweats can be a sign of a serious underlying infection or illness including TB, endocarditis (inflammation of the heart valves) and lymphoma, a type of blood cancer," says Andrew Wright, Professor of Dermatology at the University of Bradford. These conditions may cause sweating during the day, but will be more noticeable at night.

What to do: If this happens a few times a week, the problem should be investigated immediately by your GP. Natural alternative menopause remedies, such as red clover, may help, as the herb is rich in plant chemicals known as phytoestrogens, which mimic estrogen.

7. You're confused.

Known as confusional arousal, this tends to happen when something wakes us from the deep phase of sleep, but can also occur during the transition from deep to lighter sleep. "Though we may be able to speak or get up, we are not actually fully awake," explains Russell Foster, a Professor of Neuroscience at Oxford University. Confusional arousal may be a sign of sleep apnea, a chronic disorder in which you repeatedly stop breathing during the night.

What to do: Losing weight, giving up smoking and cutting down on drinking may help tackle the problem.

8. You have a headache.

It may simply be dehydration, but if an intensely painful headache wakes you up around the same time every night for weeks, you could suffer from cluster headaches, says Dr. Andy Dowson, Director of the Headache Service at King's College Hospital, London. They cause a throbbing pain, usually behind one eye, and can last from 30 minutes to three hours. Other symptoms include a blocked nose and red eyes.

What to do: Over-the-counter painkillers may not be strong enough — your doctor can prescribe stronger drugs such as verapamil. They may also suggest using an oxygen cylinder, as breathing in pure oxygen seems to help.

9. You have painful legs.

Sudden muscle spasms in the calf, thigh or foot have been linked to taking statins, but you must speak to your GP before making any changes to your medication.

What to do: Take a warm bath before going to bed to relax the muscles, says London-based Chartered Physiotherapist Sammy Margo. Drinking lots of water, particularly if exercising, will also prevent the loss of minerals from the body, which are needed to help muscles contract and relax. Stretching calf muscles before going to bed will help, too.

10. You're hungry.

There are several reasons your hunger could keep you awake. Night eating syndrome, says expert Dr. Neil Stanley, is usually caused by stress or depression. Anti-depressants may help, as can ensuring you eat regularly during the day. Waking up hungry can also be the sign of an underactive thyroid, as a lack of the hormone thyroxin slows down the metabolism, making it harder for the body to maintain even blood sugar levels. Diagnosed with a blood test, it's treated with hormone-replacement tablets called levothyroxine. Or you may have reactive hypoglycemia, a form of low blood sugar that can happen in people who don't have diabetes, says Dr. Nida Chammas, a Consultant in Diabetes and Endocrinology at BMI The Clementine Churchill Hospital. It usually results from large rises in blood sugar levels followed by a quick crash, perhaps from eating junk food or drinking alcohol.

Mouth pain may be caused by pulpitis, an inflammation of the inner part of your tooth that protects the nerve, says London-based dentist Dr. Charles Ferber. It's especially noticeable at night, since lying down puts pressure on the head and neck, aggravating the pain. A dull ache in the jaw may be due to grinding teeth, known as bruxism. Other symptoms include earache, headaches, and chipped teeth.

What to do: See your dentist as soon as possible. If pulpitis is caught early, root-canal treatment should solve the problem. If you are a tooth grinder, your dentist can make you a mouth guard — a type of splint that acts as a barrier between your upper and lower teeth. Since 70% of cases of bruxism are stress related, try deep breathing exercises and having a long bath before going to bed.

12. You're stressed or depressed.

Stress or any kind of emotional upset can increase the likelihood of waking up in the middle of the night, says Dr. Jan Wise, Consultant Psychiatrist with Central Stress Management clinic in London. "If you are emotionally disturbed, the body gets into an increased state of arousal, even when asleep. That makes you more vulnerable to factors that might not otherwise wake you up, such as a noise outside," he says. Meanwhile, waking up feeling low early in the morning is a key sign of depression.

What to do: Sleep in a darkened room and keep the temperature fairly cool — around 60°. Exercise and meditation can also help relieve stress and upset. For depression, it's important to seek treatment, which may involve counseling or anti-depressants.

13. You're thirsty.

Waking up thirsty could be a sign of undiagnosed diabetes. This is due to high blood sugar levels triggering the body to flush away excess glucose, which in turn can lead to dehydration, making you feel thirsty, explains Dr. Nida Chammas. Other symptoms include losing weight, blurred vision and excess trips to the loo, particularly at night.